Abstract
Without a better understanding of mental disease, patients diagnosed with a mental disease may be mistreated clinically and/or socially, and caregivers and families may be wrongfully blamed for causing the disease and/or for not effectively helping and developing meaningful relationships with the patient as person. In trying to understand mental disease and why its various dimensions raise difficulties for our systems of classification and our medical models of diagnosis and treatment, a framework is required. This framework will connect metaphysical, epistemological, and ethical considerations in ways that are mutually supportive and illuminating. This, in turn, will benefit those who are diseased and those persons who study, classify, diagnose, and treat disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Temple Grandin, an Assistant Professor of Animal Sciences at Colorado State University, is well known for her designs of livestock-handling facilities, which are products of a different way of thinking attributed to autism.
I use a broadly defined term of “mental disease” rather than “illness,” “disorder,” “disability,” “sickness,” or any other related term unless I am referring to a particular author’s perspective. I recognize that “mental disease” is not a term used in our everyday language. However, as a concept, describing all that may fall under negative health, it is often the target of philosophical discourse and scrutiny; my aim is to contribute to this discourse. In subsequent sections, I describe mental disease as a value-laden concept, a requirement of a holistic theory of health and its absence (i.e., disease).
Defining “embodiment” in this holistic sense requires conceptual clarity. In achieving this conceptual clarity, autistic disorder is used as an example throughout the paper to show that it does not just affect the biological body or the cognitive mind, or a combination of the two; it affects the entire person, which is much more than what traditional mind/body theories have to offer. It may be the case that the concept of embodiment, or embodied mind, may evolve and have a better “fit” into the coherence framework, but how it is conceptualized for the purposes of this discussion suggests that persons are truly a complex, organized system unable to be metaphysically dissected.
Because many autistic children cannot develop relationships and/or initiate and hold a conversation with others, clinicians once thought these behaviors to be imitations of the behaviors presented by the child’s insensitive, cold “refrigerator mother”, who failed to establish a loving relationship with her child at infancy.
While I recognize some critics would question my use of the term disease to encompass conceptions of illness, as well as Nordenfelt’s definition of disease, it requires the reader to think about those evaluative or normative elements, which often goes unnoticed when specifically thinking about what is disease.
Value-laden and value-free conceptions of mental disease are considered when viewing biomedical and psychosocial models. The conception of mental disease, the subject of disease, and clinical (psychiatric) practice, i.e., diagnosing and treating patients with mental diseases, are the elements constructing medical models; the biomedical model focuses on an organic diagnosis and treatment (e.g., affecting a patient’s neurochemistry to treat depression) and the psychosocial model focuses on psychological and social ways to understand and treat the patient (e.g., psychotherapy is used to understand what social problems may contribute to the patient’s depression). I argue that both biomedical and psychosocial models are significant for treating patients with mental diseases–a holistic model.
Writers of the DSM-IV TR(2000) explain the first official attempt to gather information about mental illness in the U.S was “the recording of the frequency of one category–“idiocy/insanity” in the 1840 census,” American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR). Washington, D.C.: American Psychiatric Association), p. xxv.
Often, clinicians relied on such analogies since they did not have the knowledge and tools to distinguish genuinely (cognitively) retarded 14-year-old adolescents from what we would now call an autistic 14-year-old. Clinicians at the time lumped together intellectual and social/emotional disorders without distinguishing the differences between them; thus, autism was understood to be an intellectual disorder in the same way mental retardation was understood.
Shortly after Kanner’s study, Asperger applied the term to children who developed obsessions for particular subjects, but who were extremely intelligent.
References
American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders, 4th edn, text revision (DSM-IV-TR).Washington, DC: American Psychiatric Association.
Banja, J. 1997. Defining disease: Praxis makes perfect. In What is disease?, ed. J.M. Humber, and F. Almeder, 249–268. Totowa, New Jersey: Biomedical Ethics Reviews, Humana Press.
Boorse, C. 1997. A rebuttal on health. In What is disease?, ed. J.M. Humber, and F. Almeder, 1–134. Totowa, New Jersey: Biomedical Ethics Reviews, Humana Press.
Brülde, B. 2007a. Mental disorder and values. Philosophy, Psychiatry and Psychology 14(2): 93–102.
Brülde, B. 2007b. Art and science, facts and knowledge. Philosophy, Psychiatry and Psychology 14(2): 112–127.
Daniels, N. 1979. Wide reflective equilibrium and theory acceptance in ethics. Journal of Philosophy 76(5): 256–282.
Gillett, G. 1999. The mind and its discontents: An essay in discursive psychiatry. Oxford: Oxford University Press.
Grandin, T. 1996. Thinking in pictures, and other reports from my life with Autism. New York: Vintage Books.
Hacker, P.M.S. 1999. Wittgenstein. New York: Routledge.
Hofmann, B. 2010. The concept of disease–vague, complex, or just indefinable? Medicine, Health Care and Philosophy 13: 3–10.
Johnson, M. 1987. The body in the mind: The bodily basis of imagination, reason and meaning. Chicago: University of Chicago Press.
Kendler, K.S. 2005. Toward a philosophical structure for psychiatry. American Journal of Psychiatry 162(3): 433–440.
Kopelman, L. 1989. Moral problems in psychiatry. In Medical ethics, ed. R.M. Veatch, 275–320. Boston: Jones and Bartlett Publishers.
Luhrmann, T.M. 2000. Of two minds: The growing disorder in American psychiatry. New York: Knopf.
Nielsen, K. 1993. Relativism and wide reflective equilibrium. Monist 76(3): 316–332.
Nielsen, K. 1989. Reflective equilibrium and transformation of philosophy. Metaphilosophy, 20(3 and 4): 235–246.
Nordenfelt, L. 2000. Action, ability and health: Essays in the philosophy of action and Welfare. Dordrecht: Kluwer.
Nordenfelt, L. 2001. Health, science and ordinary language. Amsterdam: Rodopi.
Nordenfelt, L. 2007a. Understanding the Concept of Health. http://www.fil.lu.se/HommageaWlodek/site/papper/NordenfeltLennart.pdf. Accessed: January 3, 2009.
Nordenfelt, L. 2007b. The concepts of health and disease revisited. Medicine, Health Care and Philosophy 10: 5–10.
Reich, W. 1999. Psychiatric diagnosis an ethical problem. In Psychiatric ethics, 3rd ed, ed. S. Bloch, P. Chodoff, and S.A. Green. New York: Oxford University Press.
Sacks, O. 1996. Forward. In Thinking in pictures, and other reports from my life with Autism, ed. T. Grandin. New York: Vintage Books.
Tengland, P.-A. 2007. A two-dimensional theory of health. Theoretical Medicine and Bioethics 28: 257–284.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aultman, J.M. The diseased embodied mind: constructing a conception of mental disease in relation to the person. Med Health Care and Philos 13, 321–332 (2010). https://doi.org/10.1007/s11019-010-9246-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-010-9246-3